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~~ <br />/~~.~~i <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: ,Valle Escondido ``:~'~;>~ i~~ <br />PERMIT NO.: /M-1991-133 'APR ~i 4 ZU08 <br />OPERATION NAME: Valdez Gravel Mine ision of declamation, <br />ANNIVERSARY DATE: Apri120, 2008 `~Mlnln9 and Safiety <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Conejos <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />_ .reclamation accomplished to date and during the preceding year, new-disturbances that-are anticipated to occur- - - <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous vear and no new changes to <br />the previous year's map are necessary. then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Demetrio Valdez <br />Permittee Name: Valle Escondido <br />Address: P.O. Box 84 <br />Conejos, CO 81129 <br />Phone Number: (719) 376-5873 <br />Fax Number: (719) 376-2451 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />ignature of Corporate Officer, Owner, Designee <br />Date <br />